Psoriasis is a chronic, systemic inflammatory disease with skin maniifestations resulting from a dysregulated immune response. Itching is one of the most bothersome psoriasis symptoms for patients and ... [more ▼]

Psoriasis is a chronic, systemic inflammatory disease with skin maniifestations resulting from a dysregulated immune response. Itching is one of the most bothersome psoriasis symptoms for patients and important factor contributing to disease severity. Apremilast , is an oral small-molecule phosphodiesterase 4 (PDE4) inhibitor, works intracellularly within immune cells to regulate the production of inflammatory médiators associated with the pathogenesis of psoriasis by increasing cyclic adenosine monophophate (cAMP) levels. Apremilast was approved by the US Food and Drug Administration for the treatment of adult patients with patients with active psoriatic arthritis and for patients with moderate to severe plaque psoriasis. Apremilast has since been approved in multiple countries, including those in European Union,as well as Switzerland, Canada and Australia. LIBERATE (Evaluation in Placebo-Controlled Study of Oral Apremilast and Etanercept in Plaque Psoriasis; NCT01690299) is global phase 3b study evaluating the efficacity, safety, and tolerability of apremilast or etarnercept, compared with placebo, for the treatment of biologic-naive patients with moderate to severe plaque psoriasis. [less ▲]

Background: Herpes zoster (HZ) in patients receiving tumor necrosis factor (TNF) antagonists may be more severe and the incidence seems increased. The influence of TNF antagonists on varicella zoster virus (VZV) reactivation is unknown. Objective: To prospectively search in a pilot study for VZV DNA in sequential blood samples before and after infliximab administration. Setting: University medical center. Subjects and Methods: Blood samples of six patients with longstanding and severe plaque psoriasis were taken on day 1 (before infliximab administration) and on days 2, 7, 21 and 42 for the determination of VZV viremia by ORF21 real-time polymerase chain reaction. Patients with varicella, HZ and normal subjects were included as controls. Results: None of the six patients presented VZV viremia at any of the time points. Highload viremia was present during varicella, low-load viremia in some HZ patients and no viremia in the control patients. Limitations: Small number of patients. Conclusions: In this pilot study, infliximab did not reactivate VZV and did not induce subclinical VZV viremia. [less ▲]

The zosteriform distribution of cutaneous lesions is a common disease pattern in dermatology. It describes a unilateral girdle-like distribution restricted to the sensitive nerve territory of a dermatome ... [more ▼]

The zosteriform distribution of cutaneous lesions is a common disease pattern in dermatology. It describes a unilateral girdle-like distribution restricted to the sensitive nerve territory of a dermatome. Three different pathogenic pathways can lead to a zosteriform pattern. The neural pathway uses the axons of a nerve ganglion for viral transport to a specific dermatome. The arche type is Herpes Zoster (HZ) followed by Zosteriform Herpes Simplex Virus Type (HSV) I infection. The Blaschkoid pathway uses the Blaschko lines that represent embryonic migration patterns, often mimicking a dermatomal distribution, particularly on the trunk. The isotopic pathway defines a dermatosis that exclusively develops on the site of a previously healed HZ eruption. Before a zosteriform eruption, a history of prior HZ guides the diagnosis to the isotopic pathway, mainly represented by granulomatous reactions followed by, among others, lichen planus, vasculitis and basal cell carcinoma. With no prior history of HZ recent eruptions orientate towards HZ and zosteriform HSV, whereas chronic eruptions should primarily evoke cutaneous metastases, principally from breast, ovary and lung carcinoma. This review summarizes the relevant literature and presents a clinical algorithm for the differential diagnosis of zosteriform dermatoses. [less ▲]

Basal cell carcinoma is the most frequent skin cancer. Even though metastases are exceptional, these cancers may be locally highly aggressive. The Hedgehog signaling pathway plays a significant role in ... [more ▼]

Basal cell carcinoma is the most frequent skin cancer. Even though metastases are exceptional, these cancers may be locally highly aggressive. The Hedgehog signaling pathway plays a significant role in the pathogenesis of basal cell carcinoma. Vismodegib is a selective inhibitor of this pathway and may be administered orally. Its main indication is locally advanced basal cell carcinoma, when other therapeutic options have failed or are contra-indicated. Vismodegib can also be used as prophylactic therapy in the Gorlin syndrome or basal cell nevomatosis. Its principal adverse effects are muscle spasms, alopecia and altered taste. They are frequent, but often moderate in intensity; they sometimes restrict continuation of treatment. Two clinical cases are presented, relating the efficacity and tolerance of this new therapeutic option. [less ▲]

Rosacea is a common centro-facial dermatosis with a high socio-esthétic impact. Ocular involvement is not uncommon. Different stypes are distinguished, classified into grades according to their severity ... [more ▼]

Rosacea is a common centro-facial dermatosis with a high socio-esthétic impact. Ocular involvement is not uncommon. Different stypes are distinguished, classified into grades according to their severity. This classification is essential for therapeutic management. In general, rosacea remains difficult to treat as its pathophysiology is still not entirely understood. Future research is needed for a better understanding of this disease and the development of targeted treatments. [less ▲]

Background:Treatment options for melanoma in situ (MIS) include imiquimod, radiation therapy, cryotherapy, excisional and Mohs surgery. Ingenol mebutate is a new topical treatment option recognized for actinic keratosis. Although in vitro effectiveness has been demonstrated on melanoma cell lines, its therapeutic potential for in vivo melanomas is unknown. Case Report: In 2011, a 91-year-old woman presented a thick melanoma of her cheek. The lateral sections revealed persisting in situ melanoma, which were again excised. She presented for follow-up and a recurrent MIS was evidenced centered on the previous scar. She refused further surgery and ingenol mebutate (0.015% gel) was administered on three consecutive days. One month later, a complete clinical resolution was observed. Histology and immunohistology revealed no residual MIS. Conclusion: In this patient, ingenol mebutate was successful and well-tolerated as a topical, alternative therapy for MIS after failure of other treatment options. [less ▲]

Hyaluronan (HA) is a glycosaminoglycan synthesized directly into the extracellular matrix by three hyaluronan synthases (HAS1, HAS2, and HAS3). HA is abundantly synthesized by keratinocytes but its ... [more ▼]

Hyaluronan (HA) is a glycosaminoglycan synthesized directly into the extracellular matrix by three hyaluronan synthases (HAS1, HAS2, and HAS3). HA is abundantly synthesized by keratinocytes but its epidermal functions remain unclear. We used culture models to grow human keratinocytes as autocrine monolayers or as reconstructed human epidermis (RHE) to assess HA synthesis and HAS expression levels during the course of keratinocyte differentiation. In both the models, epidermal differentiation downregulates HAS3 mRNA expression while increasing HAS1 without significant changes in hyaluronidase expression. HA production correlates with HAS1 mRNA expression level during normal differentiation. To investigate the regulation of HAS gene expression during inflammatory conditions linked to perturbed differentiation, lesional and non-lesional skin biopsies of atopic dermatitis (AD) patients were analyzed. HAS3 mRNA expression level increases in AD lesions compared with healthy and non-lesional skin. Simultaneously, HAS1 expression decreases. Heparin-binding EGF-like growth factor (HB-EGF) is upregulated in AD epidermis. An AD-like HAS expression pattern is observed in RHE incubated with HB-EGF. These results indicate that HAS1 is the main enzyme responsible for HA production by normal keratinocytes and thus, must be considered as an actor of normal keratinocyte differentiation. In contrast, HAS3 can be induced by HB-EGF and seems mainly involved in AD epidermis [less ▲]

Paecilomyces lilacinus is a ubiquitous saprophytic fungus that rarely causes infections in humans, frequently affecting the eyes and the skin. Cutaneous and subcutaneous infections mainly occur in ... [more ▼]

Paecilomyces lilacinus is a ubiquitous saprophytic fungus that rarely causes infections in humans, frequently affecting the eyes and the skin. Cutaneous and subcutaneous infections mainly occur in immunocompromised hosts but have occasionally been reported in immunocompetent patients. The clinical spectrum is highly heterogeneous and diagnosis is often delayed. A 60-year-old woman with idiopathic chronic necrotizing vasculitis treated since 10 years with a series of immunosuppressive therapies presented since three years various clinical presentations of chronic hyalohyphomycosis caused by P. lilacinus. Diagnosis was only obtained three years after the first clinical signs, following the histologic analysis of the surgical excision of a cutaneous abscess. Treatment with oral voriconazole was successful. This case report illustrates the highly heterogeneous clinical aspects of hyalohyphomycosis by P. lilacinus leading to a delay in diagnosis and treatment, particularly in the immunosuppressed patient. [less ▲]

Objectives : Dental extraction is reportes to trigger recurrent herpes labialis (RHL). Aim : This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures. Materials and methods : Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocometent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n=14; molar extraction under local anesthesia, n=15; and molar extraction under general anesthesia, n=9) and compared to 32 healthy controls (mean age 33 years). Results : None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls. [less ▲]

Varicella zoster virus (VZV) cutaneous infection occurs predominantly in epidermal and infundibular keratinocytes and accessorily in dermal dendritic cells. These latter cells play a role in cicatricial ... [more ▼]

Varicella zoster virus (VZV) cutaneous infection occurs predominantly in epidermal and infundibular keratinocytes and accessorily in dermal dendritic cells. These latter cells play a role in cicatricial processes. Two patients are presented with localized alopecia after VZV infection. A 4-year-old girl presented localized hair loss affecting about 20% of her upper right eyelash immediately following the resolution of the varicella skin lesions. No regrowth was observed after 3 months. An 80-year-old woman with a prior history of localized alopecia areata of the left occipital area presented severe left herpes zoster affecting the V1 and V2 dermatomes. At precisely the same site of the previous episode, a localized plaque of alopecia areata recurred. After topical corticosteroid therapy, a progressive hair regrowth occurred after about 3 months. These case reports are the first relating cutaneous VZV infection as the origin for permanent cicatricial alopecia and transitory alopecia areata. Localized hair loss should be added to the cutaneous complications of VZV skin infection. [less ▲]

in Journal of the European Academy of Dermatology & Venereology (2013), 27

Transverse melanonychia has multiple causes, but is principally observed as adverse effect to drug intake, such as minocyclin, zidovudine and chemotherapies, like pemetrexed,VAD (vincristine, adriamycin ... [more ▼]

Transverse melanonychia has multiple causes, but is principally observed as adverse effect to drug intake, such as minocyclin, zidovudine and chemotherapies, like pemetrexed,VAD (vincristine, adriamycin and dexamathasone) and hydroxyurea. Other causes include radiation therapy and electron beam therapy. [less ▲]

The Varicella zoster virus (VZV) is responsible for chickenpox and herpes zoster (HZ). VZV displays neuro- and epidermotropism, although other cells lines may be infected. A permissive type of VZV ... [more ▼]

The Varicella zoster virus (VZV) is responsible for chickenpox and herpes zoster (HZ). VZV displays neuro- and epidermotropism, although other cells lines may be infected. A permissive type of VZV infection in the epidermal and/or infundibular keratinocytes forms the majority of the skin lesions. This infections leads to intra-epidermal blistering, clinically characterized by vesicular lesions. During varicella, the haematogenous dissemination of VZV virions infects the dermal endothelial cells, which in their turn infect dermal dendrocytes who transport he virions to the keratinocytes of the basal layer. During HZ, the VZV virions arrive in the keratinocytes after release by the free nerve endings in close contact with the basal keratinocytes. The skin-associated immune system (SALT) furthermore determines the outcome of the virus/host cell relation. The spectrum of the VZV-related skin infections is presented with their pathogenic mechanisms, including lichenoid HZ, granulomatous HZ, verrucous HZ and follicular HZ. It is important to be aware of these manifestations of the VZV, in particular as VZV may present serious morbidity int eh immunocompromised patient. [less ▲]

The treatment of psoriasis is mainly based on anti-inflammatory and/or anti-hyperproliferative agents. The topical steroids appeared in the fifties and were the first therapeutic breakthrough for ... [more ▼]

The treatment of psoriasis is mainly based on anti-inflammatory and/or anti-hyperproliferative agents. The topical steroids appeared in the fifties and were the first therapeutic breakthrough for psoriasis, followed by methotrexate and phototherapy in the sixties, photochemotherapy (PUVA) in the seventies and acitretin and cyclosporine in the eighties. The targeted biologic therapies represent a whole new era of therapeutic possibilities with a highly beneficial safety record. The choice of treatment depends on a large series of factors, including the type and extend of the psoriasis, the patient's preferences, co-medications, comorbidities and drug tolerance. This overview presents the currently available topical and systemic agents for treating psoriasis, including topical corticosteroids, vitamin D derivatives, UV-light based therapies, methotrexate, cyclosporine, acitretin, and the biologic agents such as the TNF antagonists etanercept, adalimumab and infliximab, as well as the anti-p40 IL12/23 agent ustekinumab. Newer, very promising, agents aiming the Th17 pathway are under development for psoriasis. [less ▲]

Psoriasis affects about 2 to 3 % of the caucasian population. It is a chronic inflammatory disease affecting predominantly the skin with the involvement of autoimmune mediated mechanisms. Typical ... [more ▼]

Psoriasis affects about 2 to 3 % of the caucasian population. It is a chronic inflammatory disease affecting predominantly the skin with the involvement of autoimmune mediated mechanisms. Typical pathogenic features include an increased renewal of epidermal keratinocytes, the enlargement of the germinating compartment, papillomatosis, altered epidermal differentiation, angiogenesis, lymphangiogenesis and inflammatory infiltration. Several types of psoriasis are distinguished and may be present simultaneously in some patients. Up to 20 candidate genes have been evidenced in psoriasis. Genetic variability explains different types of the disease and influences response to therapeutics. Furthermore, psoriasis is triggered or aggravated by infections, traumatisms, medications, stress, tobacco, alcohol and endocrine factors. Severe psoriasis is frequently associated with comorbidities as obesity, diabetes, metabolic syndrome and cardiovascular diseases. For this reason, the similar pathogenic mechanisms of psoriasis and other IMID's (Immune Mediated Inflammatory Diseases) and the use of systemic treatments shared with other specialties, an updated vision of psoriasis for the internist is mandatory. [less ▲]